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LONDON, 27 January 2015 – When Ebola hit West Africa last year, it was a disease with no sign of a vaccine or cure. To those affected that may have been an indication that the wider world didn’t care about them or the diseases that affected them, but in truth there has simply been no incentive for anyone to develop these therapies. Yet now pharmaceutical companies are racing to produce an effective vaccine, and on 23 January the British company GlaxoSmithKline shipped the first 300 doses of its candidate to Liberia to start phase II trials.

At an event in the UK Houses of Parliament to discuss the economics of developing such vaccines, Jon Pender, a vice president of GSK, said he had been surprised, in the circumstances, that companies had any possible candidates at all on their shelves which could be developed and tested. He challenged suggestions that this was just because Ebola epidemics happened in poor countries where there was little scope for profit.

“That isn’t the reason why we don’t have vaccines for Ebola. The reason we don’t have a vaccine is because it wasn’t a priority for anyone, and there are understandable reasons for that…. The number of people affected each year was very small and the overall disease burden, in comparison to other disease like malaria or HIV, is tiny. The fact is that in the forty years that we have known about Ebola, including the present outbreak, there have been about 24,000 known cases. There are that many cases of malaria every hour.”

Now, clearly, it has become a priority. So if it isn’t just about money, how do you persuade the pharmaceutical industry to work on a normally obscure disease like Ebola? Adrian Thomas is a vice-president at Janssen Pharmaceutical Companies, which is also now working to get an Ebola vaccine to market. He says, “The first question is, what is the strength of the science? The second thing is to what extent there is a reward for innovation or a willingness to risk-share. And the third is, will we actually reach people? I think we have to understand what are the clear priorities for global health…

“Some companies do it for the reputation, others do it for the science or for alternative incentives. Other companies do it for direct financial reward, and I think you have to understand what are the different incentives that are necessary across that spectrum.”

Profit may not be everything, but the companies are not setting out to lose money. In this case they have been incentivized with public money – American, Canadian or European – to pay development costs, and assurances from the global vaccine alliance GAVI that there will be a market for any successful vaccine they produce, with up to $300 million available to pay for it.

Médecins Sans Frontières has been campaigning on the high and rising price of vaccines and the lack of transparency in the pharmaceutical industry, and earlier this month it published a new edition of its campaign document, the Right Shot.

Rohit Malpani is director of policy and analysis for MSF’s Vaccine Access Campaign. He told IRIN that despite substantial sums of public money poured into the development of an Ebola vaccine, very little was being demanded of the companies in return. “These vaccines are being developed with full public funding,” he says, “compensating the manufacturers for whatever investments they have to make, and for the cost of the clinical trials. Yet at this stage it is very non-transparent what the costs of development are, and not clear what guarantees there are about the outcomes and how they will ensure affordability. Governments are just writing them blank cheques.”

MSF welcomes the fact that GAVI has earmarked money to buy any successful vaccine, since that sends a signal to the manufacturers that there is a market, but thinks that GAVI should also be more demanding. Malpani says, “We are still not sure at what price it will be sold to GAVI. MSF would prefer that it is sold at or near cost. And if any cost is not covered by public funding, it’s better for that to be compensated directly, rather than through higher prices for the vaccine. The idea would be to de-link the cost of development from the final price.”

GAVI negotiates lower prices for the vaccines it buys for developing countries, but it is likely that the US or European governments will also want to stockpile some of these vaccines for their own use, and they are likely to have pay more. Malpani says MSF accepts that, but remarks that “if these countries have already paid for the development, it does seem inappropriate that they should pay all over again through high prices.”

MSF is certainly not against the development of Ebola vaccines, and intends to take part in some of the phase II clinical trials, probably at its facilities in Guinea. Julien Potet, their policy advisor on vaccines, says that planning the trial has been “a bit of a moving target”.

“Cases are declining a lot, and to demonstrate a protective effect is more difficult in a setting where there are limited or no cases. But we hope to vaccinate two groups – health workers because they are particularly exposed to the virus, and also to ring-vaccinate people who have been in contact or have a case in their neighbourhood. This is the plan today, but of course it could change.”

Others working on the response to the epidemic have more reservations about the vaccine programme. Mukesh Kapila, professor of global health at Manchester University, has just returned from West Africa. He found the affected countries alive with all kinds of stories and rumours, and he worries that time isn’t being taken to prepare people for the idea of the vaccine trials. “I am afraid they are going to think, ‘Oh, all these companies are coming to test some half-baked vaccines on black people here in Africa’. And the impact might be to put off people at risk from coming to get help, because they think, ‘Oh God, I’m going to be vaccinated’. When we do these trials for antibody response, it’s important that we do them on white people as well as black people, partly because it is important scientifically, but also because it’s important for public perception.”

More widely, Kapila thinks the rush for a vaccine may be counter-productive. “The panic associated with this epidemic has led to a lot of short cuts, with people rushing through the early phases so that human trials can start quickly. Everything may be fine, but we still don’t know how effective the vaccines are going to be. Are they going to give 90 percent protection? 80 percent? Or only 50 percent? That wouldn’t be enough.”

Kapila told IRIN: “People are expecting a vaccine to be the solution to this epidemic and it can’t be. A vaccine is no substitute for the laborious public health measures of identifying index cases, tracing and isolating contacts. By looking to a Promised Land where a vaccine is going to come and solve all our problems, we risk undermining these more important public health efforts. A huge amount of public money is going into vaccines. Once we have started we might as well finish, but I am sceptical whether it is a useful effort, on either public health or social and economic grounds.”

Toxically germ-infested unsafe drinking water is causing different form of disability among children globally, mainly caused by teratogens.

The excessive use of medication and consuming polluted water results in the development of abnormal cell tissue in unborn as well as newly born babies particularly during foetal growth, yielding a multiplex of physiochemical defects in the foetus. Improper and untreated disposal of sanitary water and untreated industrial waste is resulting in contamination of sub soil water threatening the nature.

Principal Investigators of South Asian Association for Regional Cooperation (SAARC) Sector’s Academic Alliance for Subsoil Water Toxicity Research Initiative Prof Qadhi Aurangzeb Al Hafi and Pro-Vice Chancellor of Dow University of Health Sciences (DUHS) Prof M Umar Farooq were of the view this was the first time Pakistani researchers’ study has been recognised at United Nations (UN) and Pakistan takes the historic edge of launching the first ever model of Terato-kinetc Research in the recorded history of medical sciences.The groundbreaking research document has been primed for over 1,700 international esteemed universities of the globe, in accordance with the UN mandates and conventions on the subject.

The first categorical research model was demonstrated at Higher Education Commission (HEC) Pakistan in continuum of the multi academia polygonal scientific colloquia the UN ‘International Observance Day for Disability’, at Dow University of Health Sciences Karachi followed by its academic sessions and scientific symposia at Punjab University and Higher Education Commission of Pakistan. The multi-academic colloquia consist of 9 scientific orientations, 17 confluences, 10 symposia and 19 demonstrations worldwide.

YAOUNDÉ, 26 March 2014 (IRIN) – Three new polio cases have been confirmed in Cameroon over the past two weeks, making it the country’s first outbreak since 2011 and causing alarm among health officials who link the virus’s spread to weak vaccine campaign coverage and displacement following violence in neighbouring northeastern Nigeria and the Central African Republic (CAR).
Cameroon has confirmed seven polio cases since 2013. Just one case is enough to instigate emergency country-wide vaccination measures under the national health policy. It last experienced a polio outbreak in 2009, the strain also identified in Nigeria and Chad.

The World Health Organization (WHO) has said the virus is at a “very high risk” of crossing borders, and one polio case of the same strain as in Cameroon has just been confirmed in Equatorial Guinea, which saw its last case in 1999.

Cameroon has put in place emergency measures to try to contain the virus, but weak or non-existent monitoring in the cross-border areas with Nigeria and CAR is seriously hampering any national efforts, said Paul Onambelle, a doctor at the Cité Vert district hospital in Yaoundé.

The estimated 100,000 refugees in Cameroon who have fled violence in Nigeriaand CAR make control efforts even harder, said Elisse Clarisse Onambany of the National Expanded Program on Immunization (EPI), who insists refugee children must be included in any immunization campaign, “which means the supply and resources needed must increase”, she said. Half of the refugee population is made up of children aged 11 or under, according to the health authorities.

Immunization in the Far North Region has been extended to include some of the children in the Nigerian refugee population, but thousands of children are still not being accessed because of insecurity in the border area with Nigeria, families being continually on the move, and difficult terrain, said Maria Enjema, a nurse at Far North district hospital of Maroua. “Despite continuous effort by the government to reduce the risk of polio in the north, it is very difficult for health workers to reach all the children, particularly those living along the borders with Nigeria because of the high risk [of Boko Haram-related violence] involved,” she told IRIN.

Meanwhile, ongoing polio campaigns have not always successfully reached the 90 percent of children (aged 0-5 years) needed to eliminate the disease. Some 43 percent of children in Cameroon have not received the three doses required for immunity, and 30 percent have never been vaccinated, said health officials.

The government and partners issue regular polio campaigns for children aged 0-5 in the three northern regions: Far North, North and Adamawa, where the risk of infection is high, but cultural resistance in these areas has limited campaign efforts, said Onambany. “People have different beliefs when it comes to maternal care. Some communities with various religious standpoints on the vaccine say the body is sacred and does not need any chemical to feel better, while some Cameroonians see it as some sort of a public plot.”

Many parents do not understand or believe that three oral vaccinations are required and so they drop out after the first or second round.

Loveline Penda, a mother of five in Yaoundé, told IRIN: “The numbers of vaccines keep increasing and I doubt sometimes what the difference will be if my child does not take a vaccine. Sometimes I miss out but I don’t have to worry because I just believe that my child will be fine.”

The government must take cultural resistance and lack of understanding more seriously and “work to change people’s opinions and knowledge [on polio],” said Idris Haman, a researcher at the University of Yaoundé.

Cameroon health officials are expanding the region-specific immunization campaign nationwide in April, May and June 2014, with the help of partners, said Onambany.

The National EPI will also soon launch an intensive awareness-raising campaign about the vaccination.

“The upcoming campaigns will ensure that the quality of campaign is improved by reaching children three times. We will also intensify communication and sensitization effort so that no family is left untold of the dangers of missing out vaccinations,” Onambany told IRIN.

Over recent years the government has stepped up its surveillance and response to polio, working through networks of trained staff in district hospitals, as well as with community-based monitoring networks and NGO partners. Without support from development partners like WHO and the UN Children’s Fund (UNICEF), containment issues would be lagging far behind, said the EPI.

But unless surveillance steps up across borders, the risk that the polio virus could continue to spread remains a top concern, said Onambelle.

As African countries strive to meet the UN Millennium Development Goals (MDGs) by 2015 and plot a new development agenda thereafter, health experts are gathering evidence across the continent to make a case for a greater focus on its millions of mentally ill.

Experts say investing in mental health treatment for African countries would bolster development across the continent, but national health priorities have been overtaken by the existing MDG structure, which has specific targets for diseases like malaria and HIV, placing them higher on countries’ agendas than other health issues.

“Everyone is putting their money in HIV, reproductive health, malaria,” says Sheila Ndyanabangi, director of mental health at Uganda’s Ministry of Health. “They need also to remember these unfunded priorities like mental health are cross-cutting, and are also affecting the performance of those other programmes like HIV and the rest.”

Global experts celebrated the passing of a World Health Assembly action plan on World Mental Health Day in May, calling it a landmark step in addressing a staggering global disparity: The World Health Organization (WHO) estimates 75-85 percent of people with severe mental disorders receive no treatment in low- and middle-income countries, compared to 35-50 percent in high-income countries. The action plan outlines four broad targets, for member states to: update their policies and laws on mental health; integrate mental health care into community-based settings; integrate awareness and prevention of mental health disorders; and strengthen evidence-based research.

In order for the plan to be implemented, both governments and donors will need to increase their focus on mental health issues. As it stands, the US Agency for International Development (USAID), the world’s biggest bilateral donor, will only support mental health if it is under another MDG health priority such as HIV/AIDS. Meanwhile, mental health receives on average 1 percent of health budgets in sub-Saharan Africa despite the WHO estimate that it carries 13 percent of the global burden of disease.

“Mental health hasn’t found its way into the core programmes [in developing countries], so the NGOs continue to rely on scraping together funds to be able to respond,” Harry Minas, a psychiatrist on the WHO International Expert Panel on Mental Health and Substance Abuse and director of the expert coalition Movement for Global Mental Health, told IRIN. “Unless we collectively do something much more effective about NCDs [non-communicable diseases], national economies are going to be bankrupted by the health budgets.”

According to a May report from the UN Secretary-General’s High-Level Panel of Eminent Persons on the Post-2015 Development Agenda, the MDGs have overseen the fastest reduction of poverty in human history. Yet it also acknowledges that they have done little to reach the world’s most vulnerable. The report says the MDGs were “silent on the devastating effects of conflict and violence on development” and focused too heavily on individual programmes instead of collaborating between sectors, resulting in a largely disjointed approach to health. Experts say without a more holistic approach to global health in the new development era, the world’s most vulnerable will only be trapped in that cycle.

“The MDGs were essentially a set of vertical programmes which were essentially in competition with each other for resources and for attention,” said Minas. “We’ve gone beyond that, and now understand we’re dealing with complex systems, where all of the important issues are very closely interrelated.”

Poverty and Mental Illness

In Africa, where many countries are dealing with current or recent emergencies, WHO sees opportunities to build better mental health care.

“The surge of aid [that usually follows an emergency]combined with sudden, focused attention on the mental health of the population, creates unparalleled opportunities to transform mental health care for the long term,” say the authors of the report Building Back Better: Sustainable Mental Health Care after Emergencies, released earlier this month.

In a study published in the Journal of Affective Disorders in July, researchers in northern Uganda – which, starting in the late 1980s suffered a two-decade long war between the government and the rebel Lords’ Resistance Army – monitored the impact of group counselling on vulnerable groups such as victims of sexual and domestic violence, HIV-infected populations, and former abductees of the civil war. It found that those groups who engaged in group counselling were able to return and function markedly faster than those who did not receive counselling, while reducing their risks of developing long-term psychiatric conditions.

“We need to be mentally healthy to get out of poverty,” Ethel Mpungu, the study’s lead researcher, told IRIN.

The link between mental illness and persisting poverty is being made the world over. According to a 2011 World Economic Forum report, NCDs will cost the global economy more than US$30 trillion by 2030, with mental health conditions alone costing an additional $16 trillion over the same time span.

“It really is around issues of development and economics – those things can no longer be ignored,” says Minas. “They are now so clear that ministries of health all around the place are starting to think about how they are going to develop their mental health programmes.”

Putting mental health on the agenda

As mental health legislation is hard to come by in most African countries, Uganda is ahead of most on the continent with its comprehensive National Policy on Mental, Neurological and Substance Use Services, drafted in 2010. The bill would update its colonial era Mental Treatment Act, which has not been revised since 1964, and bring the country in line with international standards, but is still waiting to be reviewed by cabinet and be voted into law.

Uganda is also part of a consortium of research institutions and health ministries (alongside Ethiopia, India, Nepal and South Africa) leading the developing world on mental health care. PRIME – the programme for improving mental health care – was formed in 2011 to support the scale-up of mental health services in developing countries, and is currently running a series of pilot projects to measure their impact on primary healthcare systems in low-income settings.

Research shows that low- and middle-income countries can successfully provide mental health services at a lower cost through, among other strategies, easing detection and diagnosis procedures, the use of non-specialist health workers and the integration of mental healthcare into primary healthcare systems.

Although a number of projects have shown success in working with existing government structures to ultimately integrate mental health into primary health care, the scaling up of such initiatives is being hindered by a lack of investment, as the funding of African health systems is still largely seen through donor priorities, which have been focused elsewhere.

“Billions of philanthropic dollars are being spent on things like HIV/AIDS or water or malaria,” said Liz Alderman, co-founder of the Peter C. Alderman Foundation (PCAF), which works with survivors of terrorism and mass violence. “But if people don’t care whether they live or die, they’re not going to be able to take advantage of these things that are offered.”

24 December 2013
Geneva/ Washington DC — Global efforts to control and eliminate malaria have saved an estimated 3.3 million lives since 2000, reducing malaria mortality rates by 45% globally and by 49% in Africa, according to the World Malaria Report 2013 published by the World Health Organization (WHO).

An expansion of prevention and control measures has been mirrored by a consistent decline in malaria deaths and illness, despite an increase in the global population at risk of malaria between 2000 and 2012. Increased political commitment and expanded funding have helped to reduce incidence of malaria by 29% globally, and by 31% in Africa.

The large majority of the 3.3 million lives saved between 2000 and 2012 were in the ten countries with the highest malaria burden, and among children aged less than five years – the group most affected by the disease. Over the same period, malaria mortality rates in children in Africa were reduced by an estimated 54%.

“This remarkable progress is no cause for complacency: absolute numbers of malaria cases and deaths are not going down as fast as they could,” says Dr Margaret Chan, WHO Director-General. “The fact that so many people are infected and dying from mosquito bites is one of the greatest tragedies of the 21st century.”

In 2012, there were an estimated 207 million cases of malaria, which caused approximately 627 000 malaria deaths. An estimated 3.4 billion people continue to be at risk of malaria, mostly in Africa and south-east Asia. Around 80% of malaria cases occur in Africa.

Malaria prevention suffered a setback after its strong build-up between 2005 and 2010. The new WHO report notes a slowdown in the expansion of interventions to control mosquitoes for the second successive year, particularly in providing access to insecticide-treated bed nets. This has been primarily due to lack of funds to procure bed nets in countries that have ongoing malaria transmission.

In sub-Saharan Africa, the proportion of the population with access to an insecticide-treated bed net remained well under 50% in 2013. Only 70 million new bed nets were delivered to malaria-endemic countries in 2012, below the 150 million minimum needed every year to ensure everyone at risk is protected. However, in 2013, about 136 million nets were delivered, and the pipeline for 2014 looks even stronger (approximately 200 million), suggesting that there is real chance for a turnaround.

There was no such setback for malaria diagnostic testing, which has continued to expand in recent years. Between 2010 and 2012, the proportion of people with suspected malaria who received a diagnostic test in the public sector increased from 44% to 64% globally.

Access to WHO-recommended artemisinin-based combination therapies (ACTs) has also increased, with the number of treatment courses delivered to countries rising from 76 million in 2006 to 331 million in 2012.

Despite this progress, millions of people continue to lack access to diagnosis and quality-assured treatment, particularly in countries with weak health systems. The roll-out of preventive therapies – recommended for infants, children under five and pregnant women – has also been slow in recent years.

“To win the fight against malaria we must get the means to prevent and treat the disease to every family who needs it,” says Raymond G Chambers, the United Nations Secretary General’s Special Envoy for Financing the Health MDGs and for Malaria. “Our collective efforts are not only ending the needless suffering of millions, but are helping families thrive and adding billions of dollars to economies that nations can use in other ways.”

International funding for malaria control increased from less than US$ 100 million in 2000 to almost US$ 2 billion in 2012. Domestic funding stood at around US$0.5 billion in the same year, bringing the total international and domestic funding committed to malaria control to US$ 2.5 billion in 2012 – less than half the US$ 5.1 billion needed each year to achieve universal access to interventions.

Without adequate and predictable funding, the progress against malaria is also threatened by emerging parasite resistance to artemisinin, the core component of ACTs, and mosquito resistance to insecticides. Artemisinin resistance has been detected in four countries in south-east Asia, and insecticide resistance has been found in at least 64 countries.

“The remarkable gains against malaria are still fragile,” says Dr Robert Newman, Director of the WHO Global Malaria Programme. “In the next 10-15 years, the world will need innovative tools and technologies, as well as new strategic approaches to sustain and accelerate progress.”

WHO is currently developing a global technical strategy for malaria control and elimination for the 2016-2025 period, as well as a global plan to control and eliminate Plasmodium vivax malaria. Prevalent primarily in Asia and South America, P. vivax malaria is less likely than P. falciparum to result in severe malaria or death, but it generally responds more slowly to control efforts. Globally, about 9% of the estimated malaria cases are due to P. vivax, although the proportion outside the African continent is 50%.

“The vote of confidence shown by donors last week at the replenishment conference for the Global Fund to Fight AIDS, Tuberculosis and Malaria is testimony to the success of global partnership. But we must fill the annual gap of US$ 2.6 billion to achieve universal coverage and prevent malaria deaths,” said Fatoumata Nafo-Traoré, Executive Director of the Roll Back Malaria Partnership. “This is our historic opportunity to defeat malaria.”

16 November 2013
Uganda’s first lady, Janet Museveni will join the Kampala Capital City Authority (KCCA) to launch a new campaign to end mother-to-child transmission of HIV/Aids.

The campaign is coordinated by the Uganda Aids Commission. UAC Director General David Kihumuro Apuuli said last week, over 1.5 million people in Uganda were living with HIV/Aids, most of them the result of the mother-to-child transmission.

He told journalists in Kampala the campaign was critical to inform HIV-positive women that they could give birth to HIV-negative children. According to 2012 national HIV/Aids indicator survey, at least 16,000 babies were born with HIV in 2011 alone.

Kihumuro hopes that with the campaign, this number will reduce, in the next year. According to the commission, 140,000 people were infected with HIV between 2011 and 2012, down from 160,000 in 2010/2011, a 13 per cent reduction.

Dr Sarah Zalwango, the HIV/Aids focal person at KCCA, said a number of activities such as male circumcision, cancer screening and counselling would take place on that day and urged people to come in huge numbers.
[Courtesy of AllAfrica News]]

South Africa is the only country in the world where a large AIDS vaccine trial is being planned, as the global scientific community struggles to find a way to eradicate HIV.

Announced at this week’s international AIDS Vaccine Conference in Barcelona, the South African trial will involve the only vaccine shown to have some effect on the virus when it was tested among 16,000 people in Thailand. Released in 2009, the Thai trial’s results showed that HIV infection rates were 31 percent lower in participants who had received the vaccine than those who had not.

“On the eve of some of the most important vaccine trials, I am proud of the critical role that the people of South Africa will play,” said Ntando Yalo from the Networking AIDS Community Of South Africa, speaking at conference opening.

But the trial’s researchers are cautious.

Glenda Gray is the South African trial’s lead researcher and executive director of the Perinatal HIV Research at the University of the Witwatersrand. She told conference delegates that trial would begin by testing the Thai vaccine on a small group of people to confirm the vaccine worked as well in South African populations as it did in Thai participants.

“It might not show the same efficacy as in Thailand,” Gray said. “For example, South African women are bigger, and have different (levels of) exposure to the virus.”

With a national HIV prevalence rate of about 17 percent, South Africans are likely to have had much more exposure to the HIV than people in Thailand, where just one percent of the population is HIV-positive. The modest protection offered by the Thai vaccine might be too weak for South Africa, Gray added.

If the vaccine is effective within this smaller group, researchers will modify it for use against the predominant strain of HIV found in South Africa. This modified vaccine would be tested on about 240 people and, if successful, move to a larger trial involving about 5,400 people.

Chasing a “Machiavellian” virus

But the virus, described as “Machiavellian” by scientist Dr Scott Hammer at the start of the conference, continues to evade almost all attempts to eradicate it.

Johnson & Johnson Head of Research Dr Jerry Sadoff said he had been involved in creating 11 vaccines, none of which had taken more than seven years to develop. HIV was the exception, he said.

“You can make a career out of the AIDS vaccine – I have been researching it for almost 30 years,” he joked.

Most vaccines train the body to recognise and kill viruses by injecting people with small, non-toxic “deactivated” parts of the virus.

The body learns to make antibodies to fight the deactivated virus, so that when it is faced with infection from the live, dangerous virus, it is able to recognise and fight it.

But HIV’s constant mutation once it is the body makes it a moving target that is hard to pin down.

About two percent of people infected with HIV are able to contain the virus so that they don’t get sick. Scientists have been studying these “elite controllers,” including sex workers in South Africa, for years but still don’t yet know how their immune systems manage to do this.

Unlocking how our immune systems can produce “broadly neutralising antibodies” to fight HIV is “one of the holy grails of vaccine design,” according to Hammer.

But as scientists struggle to unlock the secrets of our immune systems and HIV, AIDS Vaccine Conference organisers have decided to move away from narrow focus on vaccines.

About 13 years after the first AIDS Vaccine Conference was held, the Global HIV Vaccine Enterprise will open next year’s conference to a wider range of scientists working on HIV prevention methods, including antiretroviral (ARV)-based vaginal or rectal gels – or microbicides – as well as other forms of ARV-based prevention and medical male circumcision.

This much larger gathering of HIV prevention experts will convene in Cape Town next year.

Organisers also raised the issue of a therapeutic HIV vaccine for the first time. Unlike the vaccine being tested in South Africa, a therapeutic HIV vaccine would aim to treat HV infections, not prevent them. A small therapeutic HIV vaccine trial is currently underway in the United States.